Pediatric Fever Protocols

There have been several attempts at building protocols for pediatric fever in order to determine what children 3 months and younger can be discharged home. The most commonly used protocols include the Rochester, Philadelphia, and now Step-by-Step. Although there is an exceptional comparison of these protocols (Step by Step not included) from Hui et al in 2012, the most important point to remember is that all of these protocols perform similarly. It is better to use any single one of them, than to use none.

Calculators exist for the Step-By-Step and Rochester protocols at MDcalc. In addition, there is an excellent EMRAP C3 episode on the subject. Links below.

Note: 4 of 7 patients with IBI missed in the validation trial were between 21-28 days old. Recommendations from others, after validation have been to continue aggressively testing, treating, and admitting patients < 28 days old.